THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Guardianship of Case Number: (if known) REPORT OF THE GUARDIAN OF THE PERSON - MINOR 6-month Report Annual Report Other REPORTING PERIOD: 1. Guardian Name Telephone Mailing Address Guardian Name Telephone Mailing Address 2. Minor Name: Date of Birth: Mailing Address Residence Address Type of facility Telephone 3. Name of Institution (if minor is institutionalized) Mailing Address 4. Physical health of minor Significant changes since last report 5. Hospitalization(s) since last report Surgical procedure(s) since last report Illness(es) since last report 6. Mental health of minor Psychiatric treatment(s) since last report 7. Has there been any change of living conditions of the minor since the last report? Yes No If yes, please explain 8. If the minor lives with the guardian, list the names and addresses of any adults who are new to the home since the last report. Those persons must complete a Criminal Record Release Authorization form and a DHHS Record Release Authorization form and file with the court.

9. Has there been any change in the financial status of the minor since the last report? Yes No If yes, please explain:

NHJB-2170-FP (02/12/2018) Page 1 of 2 Case Name: Guardianship of Case Number: REPORT OF THE GUARDIAN OF THE PERSON – MINOR 10. Name of present school attended by the minor Grade Are there any special educational issues that have arisen since the last report? If so, please explain.

11. Guardianship should be: Continued Terminated Altered Provide any other information related to the well-being, behaviors, and care of the minor that may assist the court to better assess the general welfare of the minor.

I certify that on this date I provided this document(s) to the parties who have filed an appearance for this case or who are otherwise interested parties by: Hand-delivery OR US Mail OR Email (E-mail only by prior agreement of the parties based on Circuit Court Administrative Order).

Date Guardian Signature

Date Guardian Signature

ORDER Read and Noted. No further action is needed.

Read and Noted. The following further action is needed:

Date Marital Master

Date Signature of Judge

Printed Name of Judge

NHJB-2170-FP (02/12/2018) Page 2 of 2